Re: Patient Tardiness

August 1, 1998

Patient tardiness can be a be a problem when you have a closely

scheduled professional therapist, which is a necessity these days.

Regardless of the start time, the therapist must complete the patient

visit on schedule, or the next person in line will also be

inconvenienced.

For that reason, since we need at least 45 minutes with a patient, we

are unable to begin treatment with a patient who is 20 minutes late. We

couldn't complete it on time, and we do not have the luxury of staffing

spare therapists. We do re-appoint those patients at a time when it is

mutually convenient. We are not willing to let one patient's lateness

affect anything other than the time appointed for their own visit -- not

screw up the schedule for the therapist for the rest of the morning or

afternoon work period.

We treat an appointment as a date. It has to be at a time when both the

clinician and the patient are *really* available and will commit to

being there. We also do not have people sitting in the waiting room

much, because we promise them we'll see them at the appointed time. We,

of course, expect the same from them.

We have borrowed Blankenship's idea concerning " Unscheduled

Absences: in that a hole in the schedule caused by an absent patient is

a problem we wish to avoid. An unscheduled absence is one of which we

are not aware 24 hours in advance. Therefore, new patients sign an

agreement which accepts the personal financial responsibility to pay us

for any unscheduled absence (since the insuror won't pay us for it).

After a second unscheduled absence, they are discharged and a letter is

sent to their physician.

This is hard to do, but the physician thinks that the patient is

receiving a thorough rehabilitative program, and so does the insuror.

If that isn't happening, it makes " PT " look ineffective.

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August 4, 1998

When you continue to accommodate patients that are always tardy or have

frequent no shows, you are really saying to the patient that their compliance

does not matter. By not complying with the clinic rules, the patient carries

that into their home exercise regiment and begins to think that it is

unimportant to show up on time much less show up at all. After one incident,

I would advise the PT talking to the patient and informing him/her that due to

the focus on individual care that it is imparitive that clinic guideliness on

tardiness and now show are followed. There is a balance between being too

" soft " and too " hard " on this issue. The ultimate customer service is doing

what is best for the patient and not easiest.

Larry@...

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August 4, 1998

You are correct. You can't afford to turn folks away. As a business person

you need to politely educate late comers about your fiscal constraints.

Our experience is that few will remain chronicly tardy. You might consider

" progressive " feedback. Reminders by clerical staff, explainations by the

therapist, and then convference room meeting around the table wearing your

administrative hat.

Allan B. Trumbull, Director P.T.

Mount Clemens General Hospital

Mt. Clemens, MI 48043

atrumbul@...

> Patient Tardiness

>

> I operate a small hospital dept., which seems to be continually

> experiencing

> more than its share of patients arriving late for their apts.. We have 30

> min

> followup apts. and 1 hr evals.We have a tardy policy of 15 mins late and

> unless we can work you in we will not be able to see you. To date I don't

> believe we have been effectively implementing this policy and this may be

> the

> root of the problem. However my staff have suggested we either just remain

> with the reputation of a " drive-thru " service or we get hard. 5 tardies

> and we

> are supposed to notify the MD. 3 N/Shows and your out. My question is in a

> business where we are trying to provide the best service with the best

> outcome, the pt who arrives on time, or even early for their apt doesn't

> deserve to be penalized as a result of another been tardy. The next issue

> is ,

> in these times of financial pressure and budgetary goals, can I afford to

> turn

> anyone away and get a reputation as the dept. who won't see you, so don't

> waste your time going there! Does anyone have suggestions on how to

> cope/deal/resolve this?

>

> The second question is with those pts who are tardy should I have my

> receptionist advise them the therapist cannot see them, or should the

> therapist do it themselves? The concern is more of pt dignity and respect,

> not

> that they have afforded the therapist any by being late nonetheless. I

> believe

> it more professional of the therapist to do it, and educate at the same

> time

> the consequences of being late and losing a valuable treatment session.

>

> Thanks for all ideas to come.

>

> Lance

>

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August 4, 1998

y623@... wrote:

<snip>

My question is in a

> business where we are trying to provide the best service with the best

> outcome, the pt who arrives on time, or even early for their apt doesn't

> deserve to be penalized as a result of another been tardy. The next issue is ,

> in these times of financial pressure and budgetary goals, can I afford to turn

> anyone away and get a reputation as the dept. who won't see you, so don't

> waste your time going there! Does anyone have suggestions on how to

> cope/deal/resolve this?

When a patient arrives late, it does not mean that another patient

should be inconvenienced. The late patient will have to wait for an

opening when the therapist has time - obviously this may take a while.

This means there are some consequences for being late, but the patient

can still receive therapy if he/she needs it (which is presumably true

or he/she would not be there). The patient could wait, for example, to

take the place of another late or no-show patient. Patients on time for

their regularly scheduled appointments should be treated at thise times.

>

> The second question is with those pts who are tardy should I have my

> receptionist advise them the therapist cannot see them, or should the

> therapist do it themselves?

I think the therapist would have to do this, as only he/she will know if

there will be an opportunity to " squeeze in " the patient sometime later,

and may be able to give the patient some idea of how long he/she will

have to wait. Alternatively, the therapist can just say " Sorry, I don't

think I can make any time for you " - and double check with the patient

and receptionist to see when the next appointment is booked.

Sandy Curwin

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August 4, 1998

The problem is easiest to solve with the initial (1st) scheduling of an

appointment. Most people don't read handouts that say " be on time " (we tried

that) so, you have set the " tone " of the clinic on the phone with the scheduling

of the very first visit. Once you have a " community reputation " for being

on-time the problem will improve dramatically.

Regarding the second question.... Have the receptionist ask the therapist if

there is still time to be seen. If not, the receptionist expresses the regrets

and reminds the person of the next scheduled visit. It then becomes the role of

the manager to " back " the receptionist and therapist if the patient " goes off "

in the waiting room.

Does this solve the problem 100%....No....But, your staff will appreciate the

improved stability.

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August 5, 1998

I agree with a lot of what has been mentioned previously, but wanted to add a

little

of what we do which seems to work well. For no shows, we call the patient

after each of the first three missed visits and offer to reschedule or find

out what their situation might be that is preventing them from coming. Upon

the third no show in a row, we send them a letter signed by the PT notifiying

them they are being discharged, again mentioning our previous calls to them,

and c.c. the referring doctor. If the no shows are hit and miss we will still

d/c the patient if progress cannot be made due to their lack of attendance.

Patients are learning more and more that insurance - especially comp & auto

will not pay if the patient is not complying.

Regarding tardiness, we emphasize to them the importance of being on time, and

find that if they have truly been scheduled at a convienent time for THEM,

they are more apt to be on time or they at least call to let us know they will

be late. If they show up 10-15 minutes late, their treatment will be adjusted

accordingly, and noted in the patient chart as to why. If they are so late

that it would hamper the timliness of other patient treatments, our

receptionist has been trained to explain to them the situation, and reschedule

them accordingly.

Good luck!!

Sandy

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August 5, 1998

In regards to lateness, no shows and cancellations, My organization has the

exact same policy as Sandy's and seems to work in more than one way.

1. We keep track of patients at each appt time re: no show

2. Patients are discharged quickly and charts are not refiled and lost in the

system. This seems to keep the charting much more current as well.

Good luck

Ruth Layanni

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August 5, 1998

Sandy -

Can you describe who actually does the calls and prepares the letters. It

seems to me that many clinics would like to do this but it seems to be

something that seems to " fall through the cracks " when everyone gets busy.

Thanks

" For no shows, we call the patient

>after each of the first three missed visits and offer to reschedule or find

>out what their situation might be that is preventing them from coming. Upon

>the third no show in a row, we send them a letter signed by the PT notifiying

>them they are being discharged, again mentioning our previous calls to them,

>and c.c. the referring doctor.

R. Kovacek, MSA, PT

KovacekManagementServices, Inc.

The FOCUS Group, Inc.

20225 Danbury Lane

Harper Woods, MI 48225

Fax

Email Pkovacek@...

<http://www.theFOCUSgroup.net>

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August 5, 1998

We have implemented a system for late patients that goes as follows: The patient

is told that they are X minutes late for their treatment, but if they would like

to be treated for the remaining minutes we will be happy to see them, but

treatment will end at the regular time so as not to impact the next patient on

the therapist's list. We then inform them that if they are seen, it will count

as one of their approved visits and will ultimately impact the total amount of

care they receive. Patients quickly get the message that there are significant

consequences to coming late and demanding to be seen. We have also converted the

number of minutes late to a percentage of total treatment. For example 5 minutes

late equals 16% of their treatment. This seems to have more meaning than you are

five minutes late.

>>> Curwin 08/04/98 07:10am >>>